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Doctor’s Perspective

Bio-Identical Hormone Therapy Studies


Are there any studies on BioIdentical Hormone Replacement?


Yes! We often are asked by patients for information that can be sent to their OBGYN or insurance company regarding bio-identical hormone therapy for menopause, perimenopause or PMS.


Dr. Mahmud published a study in the journal of Gynecological Endocrinology where 97% of the patients experienced relief of menopausal symptoms. The article is called “Natural Hormone Therapy for Menopause”. A summary of the article can be read here. If you would like to receive a copy of the full article, contact us.

Dr. Mahmud’s book, Keeping aBreast, Ways to PREVENT Breast Cancer also contains a lot of great information explaining the different hormones and how bio-identical hormone replacement plays a role in helping to prevent breast cancer. A copy of Dr. Mahmud’s book is available for purchase in our clinic.


Additional studies for women Dr. Sinda often references can be looked up via the links below:


What is a Low FODMAP Diet?

headacheDo you eat the same foods every day?  
Health problems such as: digestive, headaches, low energy, depression, skin irritations, joint aches, difficulty losing weight and more may be related to a specific food or foods you eat frequently.

Many people with food sensitivities don’t even realize how awful they feel until the “trigger” foods are removed from the diet. Food reactions are a frequently overlooked cause of chronic health issues. Some reactions occur immediately after eating the food (called “food allergy”), but in other cases, symptoms may be delayed by several hours or even days (referred to as “food sensitivity” or “food intolerance”). Removing specific foods from your diet will allow your body to recover and begin to function efficiently again.  

So what is FODMAP?
FODMAP stands for Fermentable Oligo, Di, and Mono-saccharides, And Polyols. The acronym is used to describe a specific group of carbohydrates that are poorly absorbed in the small intestine and often cause symptoms such as excess gas, bloating, and diarrhea in certain individuals with irritable Bowel Syndrome (IBS) and other functional bowel disorders.

What carbohydrate foods are FODMAPs?
FODMAP carbohydrates include:

  • Certain sugars (lactose and fructose) found in foods such as mile and dairy products, fruit, honey, and high-fructose corn syrup.
  • Artificial sweeteners (polyols), especially sweeteners containing sorbitol and mannitol.
  • Certain types of fiber (fructans and galactans) found in wheat, beans, and some vegetables.

FODMAP tolerance:
All FODMAPs have the potential to cause unwanted symptoms. Yet, the degree in which FODMAPs are tolerated varies from person to person. An individual’s physical response to certain FODMAPs depends on their own person level of sensitivity. Therefore, some FODMAP groups may trigger symptoms while others might not.

Think of the small intestine as a bucket. Each person has their own size bucket, or unique tolerance for FODMAP carbohydrates. FODMAPs have a cumulative effect. That is, the amount, not just the type of FODMAP consumed matters. When FODMAP intake exceeds the amount the “bucket” can hold (the small intestine’s capacity for digestion and absorption), it overflows into the large intestine. This may lead to gas, bloating, and diarrhea.

The FODMAP approach:
It is important to understand that IBS and other functional bowel disorders are not caused by eating FODMAPs, therefore eliminating FODMAPs from the diet will not cure the disease. However, removing certain FODMAPs from the diet may greatly improve symptoms.

The FODMAP approach takes into consideration tolerance to all FODMAP carbohydrate groups, not just specific foods. Often times in an attempt to ease symptoms, individuals tend to be overly restrictive with their diet. This leads to nutritional deficiencies. The goal of the FODMAP approach is to manage symptoms while allowing for the most varied and nutritious diet possible.

Low FODMAP diet:
A low FODMAP diet aims to minimize gastrointestinal symptoms by removing common high FODMAP foods and replacing them with low FODMAP alternatives. It is intended to be a short-term diet and is usually followed for six weeks or less. It is not to be used as a permanent diet solution. After symptoms improve, high FODMAP foods are gradually added back into the diet in smaller amounts.

FODMAP Elimination diet:
A more aggressive approach is a FODMAP elimination diet. It should not be attempted without the help and supervision of either a Registered Dietitian or healthcare provider. An elimination diet is a temporary learning diet that is used to identify troublesome FODMAPs. It consists of three phases:

  • Elimination phase: all FODMAPs are eliminated from the diet for approximately 3 weeks.
  • Challenge phase: the body is challenged by reintroducing FODMAPs into the diet in an organized way. Symptoms are observed and problematic FODMAPs are identified.
  • Final phase: problem FODMAPs are incorporated back into the diet as tolerated.

Rather than excluding all FODMAPs from the diet, the goal of both diet methods is to eliminate only the FODMAPs that are problematic. With proper management, few, if any foods must be removed from the diet permanently.

Is a low FODMAP diet right for you?
A low FODMAP diet may not be appropriate for everyone. Before beginning a low FODMAP diet, first consult your healthcare provider to eliminate other causes of your symptoms. Low FODMAP diets have shown to be most successful for persons who have:

  • An official diagnosis of Irritable Bowel Syndrome (IBS), Inflammatory Bowel Disease (IBD) or other functional bowel disorder with symptoms of excess gas, bloating, abdominal pain, diarrhea/constipation, etc.
  • Tried and failed standard therapy (high-fiber diet, increased fluid intake, increased exercise, etc.)
  • Ruled out celiac disease as a possible diagnosis. This is important as restriction wheat from the diet will affect the accuracy of future celiac testing.
  • Regular or irregular intake of high FODMAP foods.
  • The desire and ability to modify their diet.

**Additional testing such as lactose and/or fructose breath tests is helpful (bot not essential) prior to beginning a FODMAP diet.

Enlist the help of a Registered Dietitian:
If it is determined that a low FODMAP diet would be beneficial to you, consulting a Registered Dietitian (RD) who specialized in gastrointestinal nutrition can increase the likelihood of your success. The RD will help to identify major FODMAP culprits in your diet and develop an individualized diet plan centered around your eating habits and food preferences to improve both symptoms and quality of life.


Try these low- FODMAP foods


Fruit Vegetables Grain Foods Milk Products Other
Banana, blueberry, boysenberry, cantaloupe, cranberry, grape, grapefruit, honeydew melon, kiwi, lemon, lime, mandarin oranges, orange, passion, fruit, raspberry, rhubarb, strawberry *Eat dried fruit in small quantities Alfalfa,
bamboo shoots,
bean shoots,
bok choy,
carrot, celery,
green beans, potatoes,
summer squash, sweet potato,
Gluten-free bread or cereal,
100% spelt bread, rice,

Lactose-free milk and yogurt, oat milk*, rice milk, soy milk*
*Check for additives

Hard cheeses, brie and camembert

Yogurt: Lactose-free varieties

Ice Cream Substitutes
Gelato or sorbet

Olive oil

Sugar* (sucrose)
artificial sweeteners not ending in “-ol” 

Honey Substitutes
Maple syrup*, molasses

*small quantities 



Avoid these foods containing FODMAPs


Fruit Vegetables Grain Foods Milk Products Other
Apples, apricots,
canned fruit,
cherries, mango, nectarines, peaches, pears, plums,
prunes, watermelon, large amounts of dried fruit or fruit juice
Artichokes, asparagus, beets, broccoli, Brussels sprouts, cabbage cauliflower, eggplant, fennel, garlic, green bell pepper, leek, mushroom, onion, snow peas, sugar snap peas, sweet corn Wheat and rye,
in large amounts
(i.e. bread, crackers,
cookies, pasta)
Milk from cows,
goats or sheep, custard,
ice cream and yogurt, soft cheeses such as cottage cheese, cream cheese and ricotta
Fructose, high fructose corn syrup, honey isomalt, maltitol, mannitol, sorbitol, sylitol 

Baked beans, chickpeas, kidney beans, lentils 



More information about FODMAP can be found here


Energizing B12 Injections

Increase Your EnergyWe are now offering Vitamin B12 Injections! Research shows that several conditions have been linked to low levels of Vitamin B12. Without knowing it, many of us are deficient in B12, especially as we age. Vitamin B12 is an important water soluble vitamin important in so many aspects of our health: tissue repair, DNA replication, blood cell production and maintenance of healthy neurologic function.

Supplementation can be helpful in treating symptoms such as fatigue, anxiety, depression and anemia. For many, B12 can boost energy and mood, increase metabolism leading to more energy and potential weight loss, improve memory and ability to concentrate and enhance immunity. Intramuscular injections can be given regularly for long-term therapy because vitamin B12 is only slowly lost from the body. Within 4 to 6 days of receiving a B12 injection, most people experience an increase in their energy level or stamina.


How can a Vitamin B12 Injection help me?

Vitamin B12 shots are designed to provide a boost in energy and a prolonged source of energy to use during the day.

What are the Vitamin B12 Deficiency Symptoms?

Vitamin B12 is unique among all the water-soluble vitamins in that it is not excreted quickly in the urine. Rather, vitamin B12 is accumulated and stored in the liver, kidney, and other body tissues. As a result of this storage factor of vitamin B12, a deficiency in this vitamin may not manifest itself or show its symptoms until after five or six years of diet with inadequate supply of vitamin B12.

Some of the most common symptoms of a Vitamin B12 deficiency are:

  • Feeling week, tired or lightheaded
  • Memory loss and or disorientation
  • Having pale skin, or white spots on the skin, resulting from melatonin becoming absent in the area

What are the Health Benefits of Vitamin B12?

There are advantages to getting Vitamin B12 in the form of Vitamin B12 injections. Because the vitamin is absorbed more quickly into the bloodstream this way, B12 injections can provide a quick energy boost. Many people who get Vitamin B12 injections notice an improvement in their energy level within a few days, if not sooner. In addition to feeling more energy, the shots can be effective in terms of clearer skin, better sleep, improved memory, and feeling less stressed.

Taking vitamin B12 as an oral tablet is another option. However, B12 pills are often not very effective. Vitamin B12 is one of the most difficult nutrients for our bodies to absorb, which is why so many people become deficient.

Where is Vitamin B12 Found?

Unlike many vitamins, B12 is not found in animals or plants; Vitamin B12 is exclusively produced by bacteria. When animals consume plants or drink water contaminated by these specific bacteria, the vitamin ends up being stored in their body, mostly in the liver. The main sources of vitamin B12 are meat, poultry, milk, eggs and fish. Naturally, those who follow a strict vegetarian diet have to rely on vitamin supplements.

How does Vitamin B12 function in my Body?

The fact is that Vitamin B12 is a Micro Nutrient that is used in the process of energy release. Without the presence of Vitamin B12 you could not burn calories and your energy would not be released. One of its key functions is to help your body in the creation of red blood cells. These cells help carry oxygen to your vital organs, including your heart and brain. This oxygen is crucial in providing you the necessary energy to get through each day.

B12 also helps with white cell production, which is vital to keeping your immune system strong, which in turn keeps you healthy. Vitamin B12 is properly maintaining your nervous system and helping to keep nerve cells healthy. This in turn keeps your brain functioning the way it should.

B vitamins also assists in the production and regulation of DNA, which is present in every cell in your body. And since this nutrient is also a very strong antioxidant, it helps fight off free radicals which can lead to cancer. It is important that your body gets some vitamin B12 every day. It helps metabolize the food you eat so you can utilize it for energy. It does this by helping turn the carbohydrates in your food to glucose. When the glucose is released into your system, it gives you energy.

How is Vitamin B12 Deficiency Treated?

Treatment is usually shots of vitamin B12 in your arm or another muscle. Typically injections once a month will reduce mild symptoms of deficiency within a few days. You don’t need to worry about getting too much vitamin B12, because your body will pass extra vitamin B12 out in the urine. Most people feel better within days of beginning treatment.

How often should I have my Vitamin B12 blood level tested?

A vitamin B12 level test measures the amount of B12 in your blood. A baseline test should be done first to determine any deficiency. After consulting with Dr. Sinda, a customized B12 injection schedule with follow-up testing will be created for you that will help to enhance your lifestyle.


If you are interested in knowing where your vitamin B12 levels is at, set up an appointment or talk to Dr. Sinda during your next follow up for a hormone re-check.


Do you have Nutritional Deficiencies?

Innovative Directions in Health Offers Micronutrient Testing


nutritional defic.









What is Micronutrient Testing?

SpectraCell’s Micronutrient tests measure the function of 35 nutritional components including vitamins, antioxidants, minerals and amino acids within our white blood cells.  Scientific evidence shows us that analyzing the white blood cells gives us the most accurate analysis of a body’s deficiencies.








Be Proactive, NOT Reactive

Achieve a higher level of wellness. Eating a balanced diet, exercising and taking a multivitamin is simply not enough. Each person’s body is unique in its own way. Due to the complexity of the human body, an individualized healthcare approach is the only way to guarantee optimal results.

Why test Micronutrients?

Nutrient status is a vital foundation of health. Each micronutrient plays an indispensable role in promoting optimal cell function. When some cells do not function at their best, the foundation of our health is compromised, setting the stage for the development of disease. Identifying and correcting nutritional deficiencies is an important step in the long-term maintenance of optimal health.

Vitamin deficiencies aren’t just a reflection of diet. Since we are all biochemically unique, nutrient deficiencies will vary from patient to patient, and do not necessarily correlate directly with nutrient intake, even among those with similar health conditions. Many factors beyond diet determine whether nutrient function is adequate. These include biochemical individuality, genetic predisposition, absorption and metabolism, age, disease conditions and medications.

What results will I see?

Lab results include an overview page with all deficiencies listed, numeric and graphic reports easily identifying deficiencies and repletion and supplementation recommendations, such as the example above.

Testing Includes: 

Vitamin A
Vitamin B1
Vitamin B2
Vitamin B3
Vitamin B6
Vitamin B12
Vitamin C
Vitamin D
Vitamin K



Alpha Lipoic Acid
Coenzyme Q10
Vitamin E

for Total Antioxidant Function

Immune Response Score

Fructose Sensitivity
Glucose-Insulin Metabolism

Oleic Acid


How do I get tested? 

Contact our office for more information or to schedule your labwork and appointment with Dr. Sinda for recommendations to help optimize your body’s function and metabolism.


Am I in Menopause?

am i in menopauseHow do I know if I’m in menopause?


Menopause is defined as having no periods for 12 consecutive months. Menopause usually occurs around the age of 50. The most common symptoms of menopause are hot flashes and vaginal dryness. Your physician may request a FSH blood test as an elevated FSH serum level can confirm menopause.

Perimenopause occurs several years before and a year after menopause in which you will experience menstrual irregularities. Perimenopause often occurs between 45-55 years of age. Symptoms may include menstrual irregularities, hot flashes, night sweats, sleep disturbances, thinning of hair, vaginal dryness and mood fluctuations. Perimenopause can be a difficult time for many woman, as your hormone levels fluctuate often.

Information about menopause and perimenopause, causes of hormone imbalances and treatment can be found here.

If you are ready to take the next step and look into treatment options, fill out this form and we will contact you to set up a consultation and evaluation. 


Myths about Menopause

Myths about Menopause

Menopause is the end of your monthly period, but it’s not the end of your life.

Here’s the truth behind some common menopause myths.


All menopausal women suffer from bad hot flashes, night sweats and have trouble sleeping.
Not all women have these symptoms. Many can go through “the change” without significant symptoms.

Women gain a lot of weight after menopause.
Although many women do gain, it is not always a problem. Often a woman’s body composition changes; such as increases in body fat% and decreases in lean body mass. Follow a good exercise routine and diet to prevent weight gain during your middle years.

A woman’s sex life is over.
Women can have a normal testosterone level and can continue to enjoy sex life. If vaginal dryness is a problem, there are lubricants and bio-identical creams that can help.

Women will continue to have normal function of other organs if they are feeling good.
Actually, women begin to develop heart disease after menopause and exceed men in this problem around age 70. They also have more bone loss, which can end up in fractures. They need to have a physician who can prevent these problems in a natural way, rather than taking synthetic drug hormones.

Women who take good care of their bodies and minds can continue to enjoy life long after menopause. For more information to find out if you are in Menopause continue reading here or schedule a meeting with Dr. Sinda.


How can I Prevent Breast Cancer?

Breast Cancer Prevention TipsDuring Breast Cancer Awareness Month, we should not only focus on the cure but also on PREVENTION.


“An Ounce of Prevention is Worth a Pound of Cure” – Benjamin Franklin


Please share these Breast Cancer Prevention tips with your loved ones.

  • Natural progesterone in a woman’s body prevents breast cancer. A large Johns Hopkins study showed a tenfold increase in cancer deaths in progesterone deficient women.
  • Women with PMS or in menopause often have progesterone deficiency, which should be identified by blood tests and treated with natural progesterone. Artificial [drug] progesterone is chemically different from natural progesterone and actually increases the risk of breast cancer. It should be avoided.
  • Breast feed, as long as possible. Your baby will be healthier and will have a higher IQ. You will be healthier, more relaxed and have less breast cancer.
  • Green tea extract is one of the most health promoting supplements. As an anti-oxidant, it is 25 times stronger than vitamin C. It reduces silent inflammation, the root cause of many diseases. It prevents growth of breast and prostate cancer and even helps reduce cholesterol and body fat. Why not take some every day?
  • Omega 3 fatty acids reduce inflammation in the body and can not only reduce heart disease, but have also been shown to reduce the risk of cancer such as breast and prostate cancer. Omega 3 intake can be increased by eating more deep sea fish and/or fish oil capsules.
  • PMS is a cyclical problem, affecting women for 1-2 weeks before their periods. It not only causes irritability, breast soreness, bloating, cravings and weight gain, but also increases the risk of breast cancer. It is related to hormonal imbalance and is not a depressive disorder, which should be constant rather than cyclical. We have avoided anti-depressants and relieved suffering for most patients with natural hormone balance.
  • If there is a family history of breast cancer (mother, aunts and siblings), consider getting genetic testing for BRCA1 and II gene abnormalities.
  • If your risk of breast cancer is judged to be higher than normal, consider adding indole 3 carbinol (I3C) to your supplements.
  • If you are having any hormonal symptoms such as hot flashes, night sweats, trouble sleeping, brain fog, vaginal dryness, lack of muscle tone, low libido, etc., see a physician who understands natural bio-identical hormones.
  • Regular exercise reduces the risk of breast cancer, by about 25%, as well as the risk of most other diseases.
  • Focus on the cruciferous vegetables (broccoli, Brussels sprouts, cabbage, cauliflower). They contain I3C which changes estrogen in to 2-hydroxyestrone, the ‘good’ estrogen.
  • Think fiber (fruits, veggies, whole grain products). Fiber will bind toxins and estrogen as they drip into the intestine, and remove them from your body.
  • Keep alcohol intake to a minimum. Red wine is a better choice, because it is full of anti-oxidants, it is an aromatase inhibitor and it has reserveratrol, which has anti-cancer activity.
  • Scientific evidence suggests breast and nipple stimulation increases the secretion of oxytocin, which not only helps remove pent-up secretions from the breast ducts, but also fights breast cancer in several ways.
  • Regularly examine your breasts, self exams can be an important way to find a breast cancer early, when it’s more likely to be treated successfully. The Five Steps of a Breast Self-Exam
  • Fibrocystic breast disease is often associated with relatively low progesterone in relation to estrogen. The best way to manage this would be to administer natural progesterone in natural ways. This could also decrease the risk of breast cancer.
  • Exposure to toxins should be minimized by all means. Start little by purchasing non-bleached coffee filters, paper, napkins, toilet tissue, tampons, etc. Daily exposure from can result in a lifetime exposure to dioxin that exceeds acceptable risks.
  • Most Minnesotans are deficient in vitamin D because of long winters and sun avoidance in the summer. This may protect them against skin cancers, but increases the risk of many cancers including breast, prostate and colon, the risk of MS and other immune diseases, hypertension, diabetes, and death from cardio-vascular problems. Make sure you know your vitamin D status and your physician knows how to replace it adequately.
  • Omega 6 fats (most vegetable oils) stimulate breast cancer if ingested with carbohydrates (inflammatory action) and inhibit it if taken in with proteins (anti-inflammatory action). If these oils are oxidized (rancid), which they become after prolonged heating or exposure to sun, they generate free radicals which promote cancer.
  • Exercise is the best medicine. Post menopausal women make their estrogen mostly in the fat cells of the body, such as those in the breast. Exercise may lower the risk by decreasing circulating levels of estrogen in the body.
  • High fiber intake not only lowers insulin, but it also has been shown to lower serum estrogen levels, a definite benefit in breast cancer prevention.
  • Every effort should be made to consume only organically grown fruits and vegetables to avoid pesticide.
  • Smoking is a cause of excessive free radical formation in the body. Smokers’ milk duct fluid often turns dark in color. A recent study in Japan found that women who smoked had a higher than normal incidence of breast cancer.
  • Intake of anti-oxidants from supplements, fruits and vegetables should be increased to decrease free radical induced initiation and promotion of cancer.
  • Eat as much fruits and vegetables as possible; but avoid some of the high-glycemic fruits (those that raise the blood sugar the highest) such as ripe bananas and pineapple.
  • Keep your hormones in balance but use ONLY natural forms “bio-Identical hormones”, given in natural ways to replenish the body’s hormones as naturally as possible; i.e. avoid pellets, estrogen by mouth, etc. Seek a health care professional who focuses on prevention and bio-identical hormone therapy.
  • If you have infertility problems, have your progesterone levels checked. If your progesterone level is consistently low, you are at a future risk for breast cancer. It should be watched and controlled by someone who understands natural bio-identical hormones. Progesterone should never be replaced by ‘progestin’ or ‘progestagen’, the artificial-synthetic and harmful ‘hormones’.
  • Keep red meat (saturated) fats to a minimum and cut out processed meat such as bacon, pastrami, salami, sausage, hot dogs, pepperoni, etc. Choose fish, poultry, or beans instead. When you eat meat, choose lean cuts and eat smaller portions. Prepare meat by baking, broiling, or poaching at lower temperatures, rather than by frying in fat or broiling/grilling at excessively high temperatures.
  • Avoid toxins. While working with household cleansers, protective gloves should be worn.
  • Keep your body in motion! Excess body fat has been found to increase the risk for breast cancer by 30% to 50% . More body fat stores more toxins, and generates more free radicals to initiate breast cancer.

Book Keeping aBreast

We feel a much greater emphasis should be placed on breast cancer prevention.

Read more tips and prevention strategies in the book, Keeping aBreast, Ways to PREVENT Breast Cancer, written by our founding physician, Dr. Khalid Mahmud.

This book can benefit women at any age to help protect against breast cancer.



If you are interested in preventing diseases and implementing Anti-Aging strategies in to your lifestyle, we can help!  Schedule your consultation.


How to Avoid Fish Oil Burps

Fishoil Burps

The most common complaint about taking fish oil is its aftertaste.

However, the benefits of taking a fish oil supplement far outweigh any of the side effects.


Here are some tips to avoid and prevent these unpleasant fishy burps:


  1. Take only pharmaceutical grade fish oil. Pharmaceutical grade is the purest form of fish oil, containing the highest concentrations of omega-3 fatty acid as well as DHA and EPA (essential fatty acids). It generally taste better and you get more benefits with fewer pills and less side effects. Look for one that will provide 2,000 – 4,000mg per day of total DHA/EPA.
  2. Start with a small dose. If you are just starting to take fish oil, take one pill per day. After a few weeks, increase dosage to two per day to feel more benefits. If your body is not used to fish oil, taking too many pills at once can cause an upset stomach.
  3. Take Fish Oil at the Beginning of a meal. Food traps the oil in the stomach and this will help to reduce side effects like fishy burps and buffer the odor. If you take the fish oil after a meal the oil does not mix as readily with the stomach’s contents, leading to more fishy burps and heartburn.
  4. Buy Enteric-coated fish oil. Enteric coating prevents the pill from dissolving in the stomach. The pill stays intact well into the intestines. Once fish oil is in the intestine, you can’t burp it back up.
  5. Freeze Fish Oil. If you are taking Enteric-Coated fish oil and still get fishy burps, store your fish oil in the Freezer. Swallowing the capsule while it is still frozen will slow the breakdown of the fish oil in the stomach to lessen burps.

Omega-3 fish oils are recommended to almost everyone to improve overall health. Fish oil supplements reduce inflammation in the body and can not only reduce heart disease, but have also been shown to reduce the risk of cancer such as breast cancer and prostate cancer.

Pharmaceutical grade fish oil can be purchased in our clinic. If you have tried all these tips and are still experience a side effect, please let us know or make an appointment with Dr. Sinda to go over your Anti-Aging supplement routine.